title: Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.
abstract: OBJECTIVE
  To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services.
  
  
  METHODS
  Integration of family planning services into HIV care and treatment clinics.
  
  
  METHODS
  A cluster-randomized trial.
  
  
  METHODS
  Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services.
  
  
  METHODS
  We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization.
  
  
  METHODS
  We collected cost data through interviews with study staff and review of financial records to determine costs of service integration.
  
  
  RESULTS
  Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted.
  
  
  CONCLUSIONS
  Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.
authors.affiliation: aCenter for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, USA bCenter for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya cBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco dIbis Reproductive Health, Oakland, California, USA.
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kevany
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.forename: George
authors.initials: G
authors.lastname: Ochieng
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Steinfeld
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Newmann
authors.forename: Cinthia
authors.initials: C
authors.lastname: Blat
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D005193:Family Planning Services / Q000191:economics* / Q000379:methods* / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control; D007630:Kenya; D008297:Male; D011247:Pregnancy